Cerebral hydatidosis, a rare clinical entity in Ethiopian teaching hospitals: case series and literature review

Background: Cerebral hydatidosis (CH) is a rare disease and unlike other body organs cerebral involvement is very uncommon and if it occurred it is often seen in pediatric patients. The aim of the study is to show the clinical and imaging features and neurosurgical outcome of CH in East African setup.
Methods: Chart and imaging (MRI, CT, US) review of four intra-operatively proven cerebral hydatidosis, three pediartric and one adult, patients was made.
Results: There were 3 pediatric cases between the age of 5 and 10 years, 2 female and 1 one male, and an adult, 29year, with cerebral hydatidosis. All of them presented with hemiparesis, nausea and vomiting and one of the pediatric patients presented in addition to the aforementioned with visual loss and seizure. All of the patients came from rural south Ethiopia (Arsi and Bale) except the adult patient but who used to live his childhood in same area came from an urban town (Dire Dawa), South East of the country. All had history of contact with pet animals (dogs). On imaging (CT and MRI) done with and without contrast there were solitary cerebral cysts with and without daughter cysts in each of the patients measuring between 6x5cm minimum and 11x11cm maximum. Two patients images showed post contrast rim enhancement with peri-lesional edema and likely to be infected cases, and the other two patients showed no enhancement and are likely to be non-infected. One of the pediatric patients had postoperative recurrence of hydatid and adjacent brain abscess and was re-operated and the cyst was removed and the abscess drained. All had uneventful postoperative recovery except one of the pediatric patient who had postoperative recurrence and brain abscess who had residual visual impairment and chronic seizure disorder.
Conclusion: Extra cerebral Hydatidosis is endemic and common in rural Ethiopian and East African settings and therefore clinicians and in particular radiologists should be aware of cerebral hydatidosis, especially in a pediatric population, if imaging reveals spherical brain cysts.